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Biomedical subjects

L Nelson

Publications and source records attributed to L Nelson.

At least 73 records · Page 4Linked to original sources
PubMed1995

Design and feasibility of a national Medicaid Access Survey with state-specific estimates.

This article presents the results of a study to design and assess the feasibility of conducting a national Medicaid Access Survey to generate timely, state-specific estimates of access to care for Medicaid enrollees. State-specific data on Medicaid access is especially relevant because state programs and environments vary considerably and are changing rapidly in ways that could influence access. We analyze (1) basic survey design parameters and instrument content, (2) alternative sampling approaches and their feasibility, (3) pilot test results, (4) the feasibility of using existing national surveys to generate comparison estimates for state-based surveys, and (5) estimates of the required sample size and costs for such a national Medicaid Access Survey. We conclude that a survey generating timely, state-specific estimates of Medicaid access is both feasible and affordable if attention is paid to key design challenges while keeping objectives and design simple.

Budgets↗
PubMed1995

Balance billing under Medicare: protecting beneficiaries and preserving physician participation.

Medicare's experience with balance billing provides valuable lessons for policy making for national or state health care reform. Medicare developed several policies to encourage physicians to become participating providers who accept Medicare-allowed charges as payment in full. Only nonparticipating physicians are permitted to bill for additional amounts beyond that paid by Medicare, and there are limits on the amount of balance billing per claim. As shown by the analysis of claims presented in this article, Medicare has successfully provided financial protection to beneficiaries. In 1986, more than 60 percent of expenditures for physician services were on assigned claims for which there could be no balance billing; by 1990, 80 percent of expenditures were on assigned claims. Balance billing decreased by about 30 percent during the same period. Although these policies have been successful in reducing total expenditures for balance billing, they may not provide financial protection to the most economically vulnerable beneficiaries. Using survey and claims data, we found that the poor have lower balance billing expenditures for services provided by primary care physicians, but that there is no relationship between poverty status and balance billing expenditures for services of nonprimary care physicians. In addition, most low-income beneficiaries are liable for balance bills. Under health care reform, adoption of Medicare's incentive-based approach with mandatory assignment for the poor would allow for some choice based on price and would provide financial protection for all consumers.

Aged↗
PubMed1995

Aplastic anemia induced by an adulterated herbal medication.

Herbal medication use is common in many cultural groups. Because these products are unregulated, the potential for significant toxicity exists. We report a case of aplastic anemia associated with the use of an herbal medication by a 12-year-old boy. On analysis, the herbal medication was found to contain phenylbutazone, which has been strongly associated with the production of similar hematologic abnormalities. The medication was not listed as an ingredient and no warning was present on the box.

Anemia, Aplastic↗
PubMed1995

Detection of Alzheimer disease in individuals with Down syndrome.

A comprehensive baseline of emotional functioning was established for adults with Down syndrome. Five emotional factors were studied using groups of (a) adults with Down syndrome (n = 30), (b) clinical control subjects with dementia of the Alzheimer type (n = 18), and (c) elderly control subjects without mental retardation (n = 25). Results of planned statistical comparisons showed indifference, pragnosia, and inappropriateness as primary emotional factors separating Down syndrome and Alzheimer disease groups from elderly control subjects without mental retardation. Indifference was also shown to covary with cognitive mental state, whereby increased levels of indifference were associated with decreased levels of cognitive functioning. The possibility of noncognitive variables signalling dementia of the Alzheimer type in individuals with Down syndrome was discussed.

Adult↗
PubMed1995

When a child dies.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed1995

A gene for familial total anomalous pulmonary venous return maps to chromosome 4p13-q12.

Total anomalous pulmonary venous return (TAPVR) is a cyanotic congenital heart defect that, without surgical correction, has a high mortality rate in the first year of life. It usually occurs without a family history and has a low recurrence risk. However, we recently reported a large Utah-Idaho family in which TAPVR segregates as an autosomal dominant trait with decreased penetrance. Linkage mapping with highly polymorphic microsatellite markers localizes the disease locus in this pedigree to the centromeric region of chromosome 4 (maximum lod = 6.51 at theta = .00). Apparent genetic anticipation in the pedigree prompted a search for expanded trinucleotide repeats by using repeat expansion detection. We have found no evidence for a trinucleotide repeat expansion that segregates with TAPVR. A vascular endothelial growth-factor receptor that is thought to have a role in vasculogenesis maps near the pericentric region of chromosome 4 and is a candidate gene for both familial and sporadic cases of TAPVR.

Chromosome Mapping↗
PubMed1994

Interstitial fluid pressure in breast cancer, benign breast conditions, and breast parenchyma.

BACKGROUND: Interstitial fluid pressure (IFP) in rodent malignant tumors is reportedly much higher than in surrounding normal tissue. We hypothesized the same may be true in human invasive breast tumors. METHODS: We measured IFP in the operating room in 25 patients undergoing excision breast biopsy under local anesthetic for diagnostic purposes. RESULTS: In patients with invasive ductal carcinomas IFP was 29 +/- 3 (SE) mm Hg, compared with -0.3 +/- 0.1 mm Hg in those with normal breast parenchyma (p < 0.001), 3.6 +/- 0.8 mm Hg in those with benign tumors (p < 0.003), -0.3 +/- 0.2 mm Hg in those with noninvasive carcinomas (p = 0.034), and 0.4 +/- 0.4 mm Hg in those with other benign breast conditions (p = 0.002). There was a direct correlation between IFP and tumor size (R2 = 0.3977; p = 0.021). No correlation was found between IFP and nuclear grade, angiolymphatic invasion, systemic blood pressure, metastasis to lymph nodes, or estrogen and progesterone receptors. CONCLUSIONS: IFP measurements may facilitate radiographic or ultrasound localization of small or nonpalpable malignant tumors in those patients undergoing needle aspiration cytology or stereotactic core needle biopsy.

Adult↗
PubMed1994

Vaccination against Staphylococcus aureus mastitis: immunological response of mice vaccinated with fibronectin-binding protein (FnBP-A) to challenge with S. aureus.

Mice were immunized with fusion proteins encompassing the fibronectin-binding domain of a staphylococcal fibronectin-binding protein (FnBP-A). A specific antibody response against the fibronectin-binding part of the fusion proteins was detected in the serum of all vaccinated animals. The protective potential of these vaccinations was evaluated in a mouse mastitis model, using Staphylococcus aureus, strain SA113, for challenge. The mice vaccinated with FnBP fusion proteins showed a decreased number of bacteria recovered from the mammary glands and significantly reduced cases of severe mastitis. Histopathological examination of tissue from challenged glands of vaccinated mice revealed either no pathological reactions or disseminated inflammatory reactions with focal necrosis whereas four of six examined tissues from challenged glands of non-vaccinated animals showed total necrosis. A combination of FnBP fusion protein with staphylococcal alpha-toxoid did not increase the efficacy of the vaccination and animals vaccinated with alpha-toxoid alone were as sensitive to challenge as those from the non-vaccinated control group. Thus vaccination of mice with recombinant FnBP resulted in significant protection against challenge with S. aureus.

Adhesins, Bacterial↗
PubMed1993

Purification and properties of UDP-glucose:thiohydroximate glucosyltransferase from Brassica napus L. seedlings.

A uridinediphosphateglucose:thiohydroximate glucosyltransferase (EC 2.4.1.-) has been purified 3700-fold from Brassica napus L. seedlings. The enzyme catalyzes the formation of desulfoglucosinolates by transfer of glucose from UDP-glucose to thiohydroximates and is believed to be the second to last step involved in glucosinolate biosynthesis. The enzyme was purified to near homogeneity, exhibiting a single band by non-denaturing polyacrylamide gel electrophoresis (PAGE) and on sodium dodecyl sulfate-PAGE (M(r) 46,000) but showed multiple isoforms between pH 4.6 and 4.3 when resolved by IEF. The enzyme is stable at temperatures up to 30 degrees C for at least 1 h and shows maximum activity rates at pH 6.0 and has no absolute requirements for cations. The Km values for UDP-glucose and phenylacetothiohydroximate were calculated to be 0.46 and 0.05 mM, respectively. This enzyme possesses a high degree of specificity for the thiohydroximic functional group but little specificity for the associated side-chain groups. Similar enzyme activity has been detected in all other members of the Brassicaceae family tested and is believed to be a common thiohydroximate glucosylating enzyme present in these and other glucosinolate producing plants.

Brassica↗
PubMed1993

A randomized trial of bromocriptine for cocaine users presenting to the emergency department.

OBJECTIVE: To determine the practicality of treating heavy cocaine users with bromocriptine in an outpatient setting to reduce cocaine use and increase entry into drug treatment. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: VA Medical Center emergency department. PARTICIPANTS: Twenty-nine men presenting for minor medical complaints who used cocaine at least four times per week for the previous month. INTERVENTION: Subjects received either bromocriptine, 1.25 mg, or placebo three times per day for two weeks. MEASUREMENTS AND MAIN RESULTS: On three follow-up visits, subjects were tested for cocaine metabolites and surveyed about their drug use and symptoms. Eight of 14 subjects randomized to the bromocriptine group appeared for follow-up evaluation and seven enrolled in drug treatment. Three of these patients tested negative for cocaine at all three visits. Ten of 15 control patients appeared for follow-up visits and five enrolled in drug treatment. None of the control patients tested negative for cocaine for all three visits. There was no major side effect. CONCLUSION: Bromocriptine can be administered safely to heavy cocaine users in an emergency department setting. The question of whether bromocriptine will reduce the use of cocaine or promote entry into drug treatment deserves further research.

Adult↗
PubMed1993

A molecular variant of angiotensinogen associated with preeclampsia.

Pregnancy-induced hypertension (PIH) is a heterogeneous disorder which complicates 5-7% of all pregnancies and remains a leading cause of maternal, fetal and neonatal morbidity and mortality. Severe preeclampsia is the most distinctive and life-threatening form; a multi-system disorder more common in first pregnancies, it is characterized by high blood pressure and proteinuria. In a series of Caucasian women with pregnancy-induced hypertension, we have observed a significant association of preeclampsia with a molecular variant of angiotensinogen, T235, found previously to be associated with essential hypertension. This finding is corroborated in a sample ascertained in Japan. Together, these observations support a new pathophysiological interpretation of preeclampsia and of its relation to some forms of essential hypertension.

Angiotensinogen↗